Basic Information
Provider Information
NPI: 1134189707
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHEN
FirstName: CHRISTINE
MiddleName: W
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20 YORK ST
Address2: CB 2041
City: NEW HAVEN
State: CT
PostalCode: 065048900
CountryCode: US
TelephoneNumber: 2036884748
FaxNumber: 2036884740
Practice Location
Address1: 20 YORK ST
Address2: CB-2041
City: NEW HAVEN
State: CT
PostalCode: 065048900
CountryCode: US
TelephoneNumber: 2036884748
FaxNumber: 2036884740
Other Information
ProviderEnumerationDate: 03/27/2006
LastUpdateDate: 11/07/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X42006CTN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X042006CTY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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